Outcomes of Open Cystolithotomy and Percutaneous Cystolithotripsy in the Management of Urinary Bladder Stone

Introduction: Urinary bladder stone occupies only 5% of all urinary tract stone. Various techniques have been used for the management of bladder stone. Open Cystolithotomy is the traditional treatment but a percutaneous approach has been also in practice. Aims: To confirm the best options between open cystolithotomy and percutaneous cystolithotripsy for the treatment of bladder stone. Methods: It is a prospective hospital based study from May 2019 to January 2021 in Nepalgunj Medical College. Total 42 patients with inclusion criteria were divided into two groups. Group I was allocated to 21 patients who were treated with open cystolithotomy while Group II were allocated to 21 patients who were treated with percutaneous cystolithotripsy. Two groups were compared for stone free rate, mean hospital stay, mean postoperative scar, mean operation time and rate of post-operative complications. Results: The stone free rate in Group I was 100 % and in Group II was 90.47 %. Mean Operation time was in Group I and Group II were 40.09+ 2.48 minutes and 31.38+15.65 days, respectively with p<0.05. Mean hospital stay was significantly low in Group II (3.71+1.87 days ) when compared to Group I (7.67+ 2.12 days) with p<0.001. Mean scar length of Group I (5.466+2.9 cm) with respect to Group II (1.04+0.09) was significantly long (p<0.01). Rate of complications were not significantly different between two groups (p>0.5). Conclusion: For management of urinary bladder stones sized up to 4 cm, both open cystolithotomy and percutaneous cystolithotripsy are effective, with a low incidence of complications. However, comparing the surgery time, hospital stay, length of scar between two procedures, percutaneous cystolithotripsy procedure is more beneficial for treatment of urinary bladder stone.

EVALUATION OF TREATMENT RESULTS OF UROLITHIASIS COMPLICATIONS AMONG COVID-19 PATIENTS

Objective. To study the peculiarities of diagnostics and treatment of urolithiasis complications among patients with new coronavirus infection COVID-19. Methods. The prospective cohort study evaluated the treatment outcomes of patients (n=146). The first group (n=30) included patients treated in infectious diseases hospital with a complicated urinary calculi disease and a new coronavirus infection COVID-19, the second group (n=116) included patients treated in the urological department of multidisciplinary non-infectious hospital due to complicated urinary tract stone disease who were not infected by new coronavirus infection COVID-19. As for COVID 19 diagnostics, patients of the first group were done PCR tests that were positive in 19 (63,3%) cases, and thoracic cavity computer tomography scanning (upon admission the percentage of pulmonary tissue involvement varied since 5% up to 90%). Results. Among the patients of the first group, elderly people prevailed (61+15 years) and there were more women among them (66%). The characteristic features of complicated urinary calculi disease in patients with COVID-19 are the prevalence of infectious and inflammatory complications (50%) and a combination of several complications of urolithiasis (40%). Among peculiarities of treatment, patients of the first group in 6.6% of cases underwent the lumbotomy with open nephrostomy, due to the spread of secondary suppurative process over the retroperitoneal space. According to the Clavien-Dindo scale, in the first group of patients the incidence of complications after surgery was 40%, in the second - 13.8%. Mortality rate in the first group reached 30%, in the second - 0.9%. The duration of hospital treatment among patients of the first group reached 21 (5-39) days, among patients of the second group - 8 (1-56) days. Conclusion. The specificity of the course associated with significant morbidity and mortality require further optimization therapeutic approachesto achieve success in patientswith complications of urolithiasis duringCOVID-19outbreak. What this paper adds The peculiarities of diagnostics and treatment of urinary tract stone disease complications among patients with new coronavirus infection COVID-19 have been studied. It is shown that the typical differences of patients with complicated urolithiasis and new coronavirus infection COVID-19 are elderly and old age, being a female, prevalence of pyelonephritis and paranephritis in clinical presentations, and presence of several combined complications of the urolithiasis. Mortality rate upon complicated urolithiasis and new coronavirus infection COVID-19 since the pandemic onset has reached 30% that demands optimization of treatment approaches in patients of this group.

Mechanisms of Delayed Lower Urinary Tract Stone Formation

Materials and methods:We analysed Holmium Laser Enucleation of Prostate (HOLEP) database consisting of 1300 patients who presented more than 18 months after undergoing the procedure with lower urinary tract symptoms (LUTS-voiding lower urinary tract symptoms, dysuria, haematuria, recurrent urinary tract infections-UTIs) second-ary to delayed lower urinary tract stone formation. Information was gathered from the case notes, imaging modalities, operation notes and pathology reports. Results:Three patients were identified who presented with delayed lower urinary tract stone formation 18 months after undergoing HOLEP. Case 1: A 68-year-old presented with a 4-cm mobile bladder stone on a retained prostatic fragment 29 months after HOLEP.Case 2: A 74-year-old presented with 2.5 cm bulbar urethral stone 18 months after HOLEP.Case 3: A 77-year-old presented with dystrophic calcification of the entire prostatic fossa 60 months after HOLEP. Conclusion:Delayed lower urinary tract stone presentation is unusual after HOLEP. Recurrent urethral pain, recurrent UTI, gross haematuria and voiding lower urinary tract symptoms in the presence of a lower urinary tract stone (bladder, prostate and urethra) with a radiolucent centre on a background of HOLEP should raise the suspicion that this may represent calcification on a prostatic tissue fragment or dystrophic calcification of the residual prostate/prostatic fossa. Careful morcellation, inspection of the prostatic fossa on withdrawing the morcellator for large residual prostate fragments still attached to the prostatic bed/bladder neck or simply stuck to the fossa (usually in a clot) will reduce the risk of retainment of such a significant prostatic fragment that can potentially cause complications in the future.